[569] This is a general rule of such importance that Galen wonders our author did not embody it in one of his Aphorisms. Galen’s observations on venesection in this commentary, and in his two treatises on this subject, are highly important. It will be remarked that three circumstances are held to form indications of the necessity for bleeding: first, if the disease be of a strong nature; second, if the patient be in the vigor of life; and, third, if his strength be entire.
[570] This section, as Galen remarks, contains a list of the principal cases in which venesection is to be had recourse to.
[571] I need scarcely point out to the professional reader that these symptoms are very descriptive of congestion in the brain, threatening an attack either of apoplexy or epilepsy. See the treatise on the Sacred Disease.
[572] Meaning apparently the great vessels. See Galen’s Commentary.
[573] The description here given of cynanche, more especially of the variety in which the ulceration spreads down to the trachea and produces engorgement of the lungs, is most characteristic, and bespeaks a great practical acquaintance with the disease. Judged of in a becoming spirit of candor, it must be admitted that even at the present day we have scarcely made any advancement in our knowledge of this subject. What are our descriptions of ulcerous sore-throat, diptherite, œdema glottidis, croup, and laryngismus stridulus, but reproductions in a divided and (may I be allowed to suggest?) a less accurate form, of the general views here presented by our author? For an abstract of the views of the other ancient authorities in medicine, see Paulus Ægineta, Book III., 27. Aretæus deserves particularly to be consulted (Morb. Acut., i., 7). It will be remarked that our author speaks of a spontaneous determination to the skin, as being calculated to remove the urgent symptoms within. Galen, in commenting upon this clause, states that some physicians were in the practice of applying to the skin certain medicines possessed of ulcerative powers, in order to determine to the surface, and thus imitate Nature’s mode of cure.
[574] Though the contents of this section are by no means devoid of interest, it must be obvious to the reader that the observations on causus are out of place here. See the Commentary of Galen.
[575] I would beg leave to direct the attention of the medical reader to the observations of our author in this and many other places on the characters of the urine in fevers. That in febrile diseases the sediment is wanting previous to the crisis, and that at and after the crisis, when favorable, the sediment becomes remarkably copious, I believe to be certain facts; and yet I question if, with all our boasted improvements in urology, they be generally known and attended to. I have called attention in the Argument to the important rule of practice which our author founds on the state of the urine at the crisis.
[576] He means by this, that the disease is not of an intermittent type.
[577] This seems the most appropriate meaning in this place, but the passage may also signify “a state of great emphysema or meteorism.” See Galen.
[578] It is impossible not to recognize here a brief sketch of delirium tremens. The trembling hands from drinking, with the subsequent delirium, can leave no doubts on the subject. See further Littré, tom. ii., p. 382.